Douglass P S, Bone R C, Rosen R L
Department of Corporate Planning, Rush-Presbyterian-St. Luke's Medical Center, Chicago.
Chest. 1988 Mar;93(3):629-31. doi: 10.1378/chest.93.3.629.
This article provides a follow-up to an evaluation originally presented in Chest of the financial impact of diagnosis related group (DRG) payment for long-term ventilator-dependent Medicare patients at Rush-Presbyterian-St. Luke's Medical Center. Since the results of our original study were presented, the Health Care Financing Administration (HCFA) has created two new DRGs for patients who have respiratory principal diagnoses to help recognize the resource intensiveness associated with mechanical ventilator support. The original 95 patients' payment, which was originally calculated to be $2.2 million below costs, was recalculated to be $1.9 million below costs, representing a 13 percent reduction in the loss. We conclude that although HCFA's recent remedial action is a step in the right direction, it provides little relief from the DRG system's financial bias against long-term ventilator-dependent patients, because the new ventilator DRGs encompass only a small segment of these patients. As an alternative approach, we recommend a single DRG for patients who, regardless of their principal diagnoses, experience chronic respiratory failure requiring a minimum of three days of continuous ventilator treatment.
本文是对最初发表于《胸部》杂志的一项评估的后续报道，该评估涉及拉什长老会圣卢克医疗中心长期依赖呼吸机的医疗保险患者的诊断相关分组（DRG）支付的财务影响。自我们最初的研究结果公布以来，医疗保健财务管理局（HCFA）为患有呼吸系统主要诊断的患者创建了两个新的DRG，以帮助认识到与机械通气支持相关的资源密集性。最初计算得出的95名患者的支付额比成本低220万美元，重新计算后比成本低190万美元，损失减少了13%。我们得出结论，尽管HCFA最近的补救措施是朝着正确方向迈出的一步，但它几乎无法缓解DRG系统对长期依赖呼吸机患者的财务偏见，因为新的呼吸机DRG仅涵盖这些患者中的一小部分。作为一种替代方法，我们建议为那些无论主要诊断如何，经历慢性呼吸衰竭且需要至少三天持续呼吸机治疗的患者设立单一的DRG。
